Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa

被引：241

作者：

Boulle, Andrew ^{[1
,2
]}

Davies, Mary-Ann ^{[1
,2
]}

Hussey, Hannah ^{[1
,3
]}

Ismail, Muzzammil ^{[1
,3
]}

Morden, Erna ^{[1
,3
]}

Vundle, Ziyanda ^{[1
,4
]}

Zweigenthal, Virginia ^{[1
,3
]}

Mahomed, Hassan ^{[4
,5
]}

Paleker, Masudah ^{[4
,5
]}

Pienaar, David ^{[6
]}

Tembo, Yamanya ^{[3
,6
]}

Lawrence, Charlene ^{[7
]}

Isaacs, Washiefa ^{[7
]}

Mathema, Hlengani ^{[7
,8
]}

Allen, Derick ^{[2
]}

Allie, Taryn ^{[1
,2
]}

Bam, Jamy-Lee ^{[1
]}

Buddiga, Kasturi ^{[1
,2
]}

Dane, Pierre ^{[1
,2
]}

Heekes, Alexa ^{[1
,2
]}

Matlapeng, Boitumelo ^{[1
,2
]}

Mutemaringa, Themba ^{[1
,2
]}

Muzarabani, Luckmore ^{[1
,2
]}

Phelanyane, Florence ^{[1
,2
]}

Pienaar, Rory ^{[1
]}

Rode, Catherine ^{[1
,2
]}

Smith, Mariette ^{[1
,2
]}

Tiffin, Nicki ^{[1
,2
,9
,10
]}

Zinyakatira, Nesbert ^{[1
,3
]}

Cragg, Carol ^{[11
]}

Marais, Frederick ^{[11
,12
]}

Mudaly, Vanessa ^{[3
,11
]}

Voget, Jacqueline ^{[11
]}

Davids, Jody ^{[13
]}

Roodt, Francois ^{[13
]}

Smit, Nellis van Zyl ^{[13
]}

Vermeulen, Alda ^{[13
]}

Adams, Kevin ^{[14
,15
]}

Audley, Gordon ^{[14
,16
]}

Bateman, Kathleen ^{[14
,16
]}

Beckwith, Peter ^{[14
,16
]}

Bernon, Marc ^{[14
,15
]}

Blom, Dirk ^{[14
,16
]}

Boloko, Linda ^{[14
,16
]}

Botha, Jean ^{[14
,16
]}

Boutall, Adam ^{[14
,15
]}

Burmeister, Sean ^{[14
,15
]}

Cairncross, Lydia ^{[14
,15
]}

Calligaro, Gregory ^{[14
,16
]}

Coccia, Cecilia ^{[14
,16
]}

机构：

[1] Western Cape Govt Hlth, Hlth Impact Assessment, Cape Town, South Africa

[2] Univ Cape Town, Ctr Infect Dis Epidemiol & Res, Sch Publ Hlth & Family Med, Cape Town, South Africa

[3] Univ Cape Town, Sch Publ Hlth & Family Med, Cape Town, South Africa

[4] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Global Hlth, Div Hlth Syst & Publ Hlth, Stellenbosch, South Africa

[5] Western Cape Govt Hlth, Metro Hlth Serv, Cape Town, South Africa

[6] Western Cape Govt Hlth, Rural Hlth Serv, Cape Town, South Africa

[7] Western Cape Govt Hlth, Communicable Dis Sub Directorate, Cape Town, South Africa

[8] Natl Hlth Lab Serv, Natl Inst Communicable Dis, Johannesburg, South Africa

[9] Univ Cape Town, Wellcome Ctr Infect Dis Res Africa, Cape Town, South Africa

[10] Univ Cape Town, Div Computat Biol, Cape Town, South Africa

[11] Western Cape Govt Hlth, Hlth Programmes Directorate, Cape Town, South Africa

[12] North West Univ, Fac Hlth Sci, Potchefstroom, South Africa

[13] Western Cape Govt Hlth, George Hosp, Cape Town, South Africa

[14] Western Cape Govt Hlth, Groote Schuur Hosp, Cape Town, South Africa

[15] Univ Cape Town, Dept Surg, Cape Town, South Africa

[16] Univ Cape Town, Dept Med, Cape Town, South Africa

[17] Univ Cape Town, Dept Radiol, Cape Town, South Africa

[18] Western Cape Govt Hlth, Karl Bremer Hosp, Cape Town, South Africa

[19] Western Cape Govt Hlth, Khayelitsha Dist Hosp, Cape Town, South Africa

[20] Western Cape Govt Hlth, Mitchells Plain & Heideveld Hosp, Cape Town, South Africa

[21] Western Cape Govt Hlth, Tygerberg Hosp, Cape Town, South Africa

[22] Stellenbosch Univ, Dept Med, Stellenbosch, South Africa

[23] Stellenbosch Univ, Dept Obstet & Gyneacol, Stellenbosch, South Africa

[24] Western Cape Govt, Emergency Med Serv, Cape Town, South Africa

[25] Western Cape Govt Hlth, Cape Town, South Africa

[26] City Hlth, Community Serv & Hlth, City Of Cape Town, South Africa

[27] South African Med Res Council Burden Dis Res Unit, Cape Town, South Africa

[28] Univ Western Cape, Sch Publ Hlth, Cape Town, South Africa

[29] Univ Witwatersrand, Sch Pathol, Johannesburg, South Africa

[30] Univ Cape Town, Sch Pathol, Cape Town, South Africa

[31] Univ Cape Town, Natl Hlth Lab Serv, Sch Pathol, Cape Town, South Africa

[32] Univ Cape Town, Sch Pathol, Div Virol, Cape Town, South Africa

[33] Univ Cape Town, Div Emergency Med, Cape Town, South Africa

[34] Univ Cape Town, Div Immunol, Cape Town, South Africa

[35] Univ Cape Town, Inst Infect Dis & Mol Med, Cape Town, South Africa

[36] Univ Pretoria, Pretoria, South Africa

[37] Univ Witwatersrand, Sch Publ Hlth, Johannesburg, South Africa

[38] Univ Witwatersrand, South African Med Res Council Antibody Immun Res, Johannesburg, South Africa

[39] Univ Witwatersrand, Ctr Aids Programme South Africa CAPRISA, Johannesburg, South Africa

来源：

CLINICAL INFECTIOUS DISEASES | 2021年 / 73卷 / 07期

基金：

英国惠康基金;

关键词：

COVID-19; HIV; tuberculosis; sub-Saharan Africa; antiretroviral;

D O I：

10.1093/cid/ciaa1198

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. Methods. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector "active patients" (>= 1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. Results. Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70-2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81-4.04] and 1.51 [95% CI, 1.18-1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96-2.86); population attributable fraction 8.5% (95% CI, 6.1-11.1). Conclusions. While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.

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页码：E2005 / E2015

页数：11

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